Bart is a patient is a 67-year-old male with T2 DM. He is on ...

[Kikoku]

Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst.
 
  His wife tells you Bart does not follow his meal plan or exercise regularly, and hasn't checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment?
  1. Diabetic keto acidosis (DKA)
  2. Hyperglycemic hyperosmolar syndrome (HHS)
  3. Infection
  4. Hypoglycemia

Question 2

A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication this morning and ate a bagel and coffee for breakfast. BP is 110/70 and random finger-stick glucose is 64.
 
  How should this patient be treated?
  1. 12 oz apple juice with 1 tsp sugar
  2. 10 oz diet soda
  3. 8 oz milk or 4 oz orange juice
  4. 4 cookies and 8 oz chocolate milk

[Alyson.hiatt@yahoo.com]

Answer to Question 1

ANS: 2
RATIONALE: HHS is the most likely diagnosis based on diagnosis, age, and signs and symptoms. DKA may occur in T2 diabetes, but initially HHS would be suspect.

Answer to Question 2

ANS: 3
RATIONALE: Approximately 15 grams of fast-acting CHO is the treatment of choice. Diet soda would not treat hypoglycemia. The other choices would overtreat and cause rebound hyperglycemia.